Value-Based Programs Lead – VBP Design

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🇺🇸 United States – Remote

💵 $104k - $143k / year

⏰ Full Time

🟠 Senior

✍️ Designer

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Humana

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1961

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Humana is a healthcare company dedicated to making a positive impact on the health of individuals, communities, and the healthcare system as a whole. With a focus on putting health first, Humana serves a diverse range of populations, including seniors and the military, providing Medicare Advantage HMO, PPO, and PFFS plans. Humana is committed to fostering a culture of belonging and mutual respect, offering competitive and flexible benefits to ensure the financial security of its employees and their families. The company prides itself on creating an inclusive workplace where everyone has the opportunity to succeed.

📋 Description

• Support successful value-based provider relationships, focusing on provider experience and path-to-value goals • Lead end-to-end operational support of specialty Medicaid value-based payment models • Develop innovative VBP models for behavioral health, maternity, specialty providers, and social determinants of health • Create glide paths to move providers from volume to value • Align new VBP model development with segment roadmaps, Medicaid contractual requirements, and RFP commitments • Analyze financial, utilization, and performance data to identify quality improvement and total-cost-of-care reduction opportunities • Create VBP payment strategies and model designs, including payment logic, performance metrics, benchmarks, and financial terms • Design and contribute to provider reporting packages explaining overall and detailed performance • Partner with finance on impact analysis and modeling for new VBP models • Collaborate with matrixed teams to operationalize and roll out new VBP models • Identify and help resolve operational gaps • Monitor VBP model performance KPIs and enhance model design using feedback and performance data • Translate strategy into models that can be piloted and scaled across markets

🎯 Requirements

• Bachelor's degree • Minimum five (5) years of experience in managed care operations, provider reimbursement and analytics, and value-based care • Two (2) or more years of direct experience designing, structuring, and implementing value-based payment (VBP) strategies and models for specialty providers • Experience with pay-for-performance, bundled payments, accountable care, shared savings, and shared-risk arrangements • Experience using financial, utilization, quality, and performance data to design and model VBP arrangements • Experience establishing baselines and benchmarks, identifying cost and utilization opportunities, setting performance targets, and developing incentive, shared-savings, and risk methodologies • Experience operating in a matrixed environment • Expertise in Medicare and/or Medicaid managed care • Ability to identify, structure, and solve complex business problems • Excellent interpersonal, organizational, written, and oral communication and presentation skills • Proven experience writing and delivering presentations to members of the management team • Preferred: Master's degree • Preferred: Expertise in VBP financial modeling and impact analysis • Preferred: Direct experience working for a Medicaid managed care health plan • Ability to work remotely from a dedicated space without ongoing interruptions • Home internet with minimum download speed of 25 Mbps and upload speed of 10 Mbps

🏖️ Benefits

• Bonus incentive plan based on company and/or individual performance • Medical, dental, and vision benefits • 401(k) retirement savings plan • Paid time off • Company and personal holidays • Paid parental and caregiver leave • Short-term and long-term disability • Life insurance • Remote work arrangement • Up to 10% travel for onsite meetings • Dedicated home workspace and internet requirements supporting remote work

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